Membership Application

Please note: once capacity has been reached for a classroom, students will be placed on a waitlist in the order in which they are received. Priority is given to siblings of currently enrolled students.

A tour, interview with the Director, and one-time, non-refundable enrollment fee are all required before enrollment is confirmed.

Student Name

First Name

Last Name

Date of Birth

YYYY

School Year

Grade Enrolling

Program

Core Lang. Arts & Math: 4-Day Program (M-Th, 9am-1pm)

Core Lang. Arts & Math: 2-Day Program (M/W, 9am-1pm)

Core Lang. Arts & Math: 2-Day Program (T/Th, 9am-1pm)

Enrichment: 4-Day Program (M-Th, 1-3pm)

Enrichment: 2-Day Program (M/W, 1-3pm)

Enrichment: 2-Day Program (T/Th, 1-3pm)

Adventure Friday: Drop-Off

Before-Care (8-9am)

After-Care (3-4pm)

Legal Guardian's Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Tell us what excites your child? What are his/her interests or favorite subjects in school? Or anything else you'd like to add!

Does your child have any siblings? If so, what age(s)?

Does your child have an IEP or any special needs? If so, please briefly explain.

If your child was previously enrolled at another school, what encouraged you to seek an alternative choice?

How did you hear about us?

Do you have any questions or concerns about our program?

Please use this space for any additional information you'd like to add to your application.

A tour, interview with the Director, and one-time, non-refundable enrollment fee are required before enrollment is confirmed.

Village Academy San Diego strives to have an inclusive and diverse population of students and families. We do not discriminate on the basis of race, color, national and ethnic origin, or gender identity in the administration of our educational or admission policies, scholarship programs, or any other learning center administered programs.